Provider Demographics
NPI:1295031490
Name:NEGRON, ELOISA (LMSW)
Entity Type:Individual
Prefix:
First Name:ELOISA
Middle Name:
Last Name:NEGRON
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:ELOISA
Other - Middle Name:
Other - Last Name:NEGRON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMSW
Mailing Address - Street 1:800 GRAND CONCOURSE APT 1BN
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10451-3029
Mailing Address - Country:US
Mailing Address - Phone:917-842-1259
Mailing Address - Fax:
Practice Address - Street 1:2550 WEBB AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10468-3930
Practice Address - Country:US
Practice Address - Phone:646-891-6059
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-04
Last Update Date:2016-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYP78760104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker